Talking indirectly.

I learned a lesson earlier this week. We've been through a fairly significant amount of cross-cultural training in the recent past. Yet no amount of training can hammer home a lesson as efficiently as real life.

Honduran culture is based on shame. As such it is a very indirect culture, and when I ask questions to my patients they tell me what they think I want to hear, rather than what the truth actually is. One of the Honduran docs grabbed me in between cases on Monday to see a patient in their clinic who had a hernia. It was a significant hernia, which the patient reported having for the past 7 years. I did have space on Tuesday so I offered to do the surgery the following day, which the patient agreed to. I proceeded with the whole spiel about risks, benefits, options, etc which he expressed understanding and consented to surgery. Tuesday comes, and he doesn't show up.

The patient had saved just to afford to be seen by a doctor on Monday, and therefore couldn't afford the surgery with such a short turn around. But he couldn't tell me that. He told me yes. Would have told me yes to whatever I offered. In the past, when I have not been able to attend to the patient immediately I tell the Honduran doc what to offer, for example surgery on Friday. Frequently the doc comes back to me saying; the patient can't get the money by Friday and he's asking if it can be done in two Fridays. In such a case, the Honduran doc is acting as a neutral third party through whom the patient can safely answer me without any undo shame.

So going forward I'll have to remember to offer two options. The first option, and a second perhaps a week or two after the first, and then see how they respond.

I recognized another example of this when talking with Jake earlier today. He was explaining his tentative plan to move the incinerator himself on Saturday, rather than having the maintenance guys have a go at it. I asked him if he had discussed that plan with the head of maintenance to which he responded he hadn't, immediately justifying his lack of communication nervous that if he did relay his plan, maintenance would interpret that they needed to drop everything and move the incinerator themselves that very moment. hmmmm, maybe we need to find a neutral third party through whom we can have a conversation with maintenance.

Much Love.

P.S. Update on Visa extensions: We both have finally been granted our Visa extensions. It was a rather indirect and circuitous route, but somehow that seems appropriate for this post.

And just because I don't have another photo to post, here's some sweaty white guys attempting to organize a container of...stuff. The risk of heat stroke is real! Note that I was standing across the path in the shade. ;D